Marit Rokne Bjørgaas, MD, PhD, of the Norwegian University of Science and Technology (NTNU) and St Olav's University Hospital, Norway recruited patients for neuropsychological web-based tests assessing verbal, spatial and working memory, as well as executive function, processing speed and pattern separation.

105 patients were involved: 33 had type 1 diabetes and impaired hypo awareness, 35 had type 1 diabetes with normal awareness, and 37 were healthy controls. Age and gender distribution were similar among all groups, while the mean HbA1c and percentage of participants without retinopathy did not differ between groups.

Lower test scores

Brian Frier, MD, Honorary Professor of Diabetes at the University of Edinburgh, told Medscape Medical News: "I think it's a very important question that has to be addressed. It's a very nice study and they've done it very carefully."

However, Frier advised caution regarding the findings. "These people would probably be perfectly normal in most ways. When you put them under a testing situation in a laboratory, then you find abnormalities. It doesn't mean most of these people with impaired awareness are going around with severe cognitive impairment."

Furthermore, a limitation of the study was that the IQ levels of participants were not noted in patients prior to hypo unawareness developing. If patients are cognitively impaired before having hypo unawareness, they may be less able to control their diabetes.

Dr Bjørgaas said: "We did not assess premorbid intelligence or cognition, so causality can't be inferred. But we hypothesize that the cognitive impairment may have been caused by recurrent episodes of severe hypoglycemia."

75 per cent report that their understanding of hypo awareness improved after taking part in the Hypo Awareness Program, a completely free education course.

The Hypo Awareness Program focuses on improving your knowledge of hypo symptoms. It takes 30 seconds to sign up and can be completed at your own pace. It can also result in fewer cases of severe hypoglycemia among people with diabetes.